Since the start of the COVID-19 pandemic, FBI data shows that people of Asian descent increasingly have been targets of racially motivated attacks.
"Hate crimes have spilled over to affect the community in dramatic ways. People feel scapegoated and blamed for the pandemic," said Dr. Howard Kyongju Koh, the Harvey V. Fineberg Professor of the Practice of Public Health Leadership at Harvard University's T.H. Chan School of Public Health in Boston.
That has fueled a rise in anxiety and depression in a population that is already one of the least likely to access much-needed mental health services, according to the nonprofit Mental Health America.
Koh, who is a former U.S. assistant secretary for health and of Korean descent, has written extensively about racially motivated violence against Asian Americans and its health consequences. A recent article he co-wrote in the journal Health Affairs cites national polls from 2020 and 2021 in which more than a third of Asian adults in the U.S. said their mental health worsened during the pandemic, with 58% saying reports of violence against other Asian people affected their mental health.
In 2019, just 9%-10% of U.S. adults of Asian descent reported mental health issues, according to federal statistics. A 2021 survey by the Asian American Psychological Association showed the level at more than 40% since the arrival of COVID-19. Among Native Hawaiian and Pacific Islander adults in the AAPA survey, 38% reported symptoms of depression or anxiety.
But according to the Department of Health and Human Services' Office of Minority Health, Asian Americans are 60% less likely and Native Hawaiians and Pacific Islanders three times less likely to receive mental health services than their white peers. When they do seek help, according to the AAPA, they face challenges: 62% of Asian Americans and 41% of Native Hawaiians and Pacific Islanders diagnosed with mental health conditions said they needed assistance accessing care.
The effects of not getting that help go beyond the psychological, potentially causing long-lasting harm to their hearts.
Research published in January in the journal BMJ Open linked living in areas with high levels of hate crimes to a greater risk for heart disease risk factors such as high blood pressure, diabetes and obesity. Studies also show a strong association between anxiety and depression and a higher risk for heart disease.
Structural inequities are among the reasons people of Asian, Native Hawaiian and Pacific Islander background may not get the help they need. Research, for example, is limited by minimal funding – just 0.17% of the National Institutes of Health research budget is committed to studying health effects on Asian American, Native Hawaiian and Pacific Islander (AANHPI) adults.
Then, there is the problem of aggregation of data under such a broad umbrella. "This population is extremely heterogenous, covering about 100 languages and 50 ethnicities," said Koh. "The term 'Asian American' is about as useful as the term 'European American.'"
According to the U.S. Census Bureau, roughly 24 million people of Asian descent lived in the United States in 2020, with roots in more than 20 countries in East and Southeast Asia and the Indian subcontinent. With an additional 1.6 million Native Hawaiian and Pacific Islanders, AANHPI individuals make up about 7% of the U.S. population.
One reason people in Asian American communities are less likely to use mental health services stems from how they determine when a problem rises to the level of needing professional assistance, said David Takeuchi, an associate dean for faculty excellence and professor at the University of Washington in Seattle. Takeuchi has been researching how Asian American adults address mental health issues and how the pandemic has impacted their need for services.
"If it's more an emotional problem and not a physical illness, they may see it as something they can work through, unless it interferes with functioning of daily life," he said.
Stigma also plays a role, Koh said. "People may feel pressure to live up to a model minority stereotype and experience some sense of shame and stigma when they are not able to do so," he said. "Stoicism may also be a factor for some who then only seek help when symptoms are severe."
But stigma doesn't affect only the individual, Takeuchi said. In his research, which is not yet published, he found Asian American adults were concerned about embarrassing their family if they sought mental health services. If family members consented, he said, "they were more likely to see a specialist."
People in Asian American communities also may face language barriers and lack confidence in their ability to navigate the U.S. health care system, Koh said.
"We have a system that is hard to navigate for anybody," he said. "And they may not feel the clinicians who are assigned to them are sensitive to their issues."
When they do get help, it's more likely to be through community service agencies, such as local and national nonprofit organizations or university-based counseling and referral services, than through private providers, Takeuchi said. Over the past decade, those agencies have stepped up efforts to spread information about their services, but the pandemic has stretched resources thin.
Asians Do Therapy is one initiative that grew out of the need for a more culturally relevant approach to mental health services. The website highlights the therapy experiences of Asian American celebrities and others and offers tips on how to find an appropriate therapist, questions to ask to make sure it's a good fit, and advice on how to find free or reduced-fee services. The Asian Mental Health Collective provides a national directory of Asian American therapists and a list of related resources, such as human service and mental health agencies that can provide support.
Takeuchi said many agencies offer help, "but people just may not know about their existence. There have been a lot of informational campaigns, but it remains a major issue."
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